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ERIC Number: EJ917315
Record Type: Journal
Publication Date: 2011
Pages: 17
Abstractor: As Provided
ISSN: ISSN-0022-2194
Executive Impairment Determines ADHD Medication Response: Implications for Academic Achievement
Hale, James B.; Reddy, Linda A.; Semrud-Clikeman, Margaret; Hain, Lisa A.; Whitaker, James; Morley, Jessica; Lawrence, Kyle; Smith, Alex; Jones, Nicole
Journal of Learning Disabilities, v44 n2 p196-212 Mar-Apr 2011
Methylphenidate (MPH) often ameliorates attention-deficit/hyperactivity disorder (ADHD) behavioral dysfunction according to "indirect" informant reports and rating scales. The standard of care behavioral MPH titration approach seldom includes "direct" neuropsychological or academic assessment data to determine treatment efficacy. Documenting "cool" executive-working memory (EWM) and "hot" self-regulation (SR) neuropsychological impairments could aid in differential diagnosis of ADHD subtypes and determining cognitive and academic MPH response. In this study, children aged 6 to 16 with ADHD inattentive type (IT; n = 19) and combined type (n = 33)/hyperactive-impulsive type (n = 4) (CT) participated in double-blind placebo-controlled MPH trials with baseline and randomized placebo, low MPH dose, and high MPH dose conditions. EWM/SR measures and behavior ratings/classroom observations were rank ordered separately across conditions, with nonparametric randomization tests conducted to determine individual MPH response. Participants were subsequently grouped according to their level of cool EWM and hot SR circuit dysfunction. Robust cognitive and behavioral MPH response was achieved for children with significant baseline EWM/SR impairment, yet response was poor for those with adequate EWM/SR baseline performance. Even for strong MPH responders, the best dose for neuropsychological functioning was typically lower than the best dose for behavior. Findings offer one possible explanation for why long-term academic MPH treatment gains in ADHD have not been realized. Implications for academic achievement and medication titration practices for children with behaviorally diagnosed ADHD will be discussed. (Contains 2 figures and 1 table.)
SAGE Publications and Hammill Institute on Disabilities. 2455 Teller Road, Thousand Oaks, CA 91320. Tel: 800-818-7243; Tel: 805-499-9774; Fax: 800-583-2665; e-mail:; Web site:
Publication Type: Journal Articles; Reports - Research
Education Level: Elementary Education; Grade 1; Grade 10; Grade 11; Grade 2; Grade 3; Grade 4; Grade 5; Grade 7; Grade 8; Grade 9; High Schools
Audience: N/A
Language: English
Sponsor: N/A
Authoring Institution: N/A
Identifiers - Assessments and Surveys: Conners Rating Scales; Conners Teacher Rating Scale; Continuous Performance Test; Child Behavior Checklist; Stroop Color Word Test; Trail Making Test